Healthcare Provider Details

I. General information

NPI: 1114378841
Provider Name (Legal Business Name): PHILLIP STANDEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E MCDOWELL RD
PHOENIX AZ
85006-2502
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-3339
  • Fax: 602-839-3300
Mailing address:
  • Phone: 602-262-8917
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number008323
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: